This Angel is pissed off. I'm Nurse Anne and I work on large general medical ward in the NHS. These are the wards with the most issues surrounding nursing care. The problems are mostly down to intentional understaffing by hospital chiefs that result in a lack of real nurses on the wards.
"The martyr sacrifices themselves entirely in vain. Or rather not in vain, for they merely make the selfish more selfish, the lazy more lazy and the narrow more narrow"-Florence Nightengale

Saturday, 16 May 2009

Coloured Coded Uniforms? They won't change a thing.

"Colour-coded nurses' uniforms to help patients in Wales recognise who is in charge on hospital wards are being unveiled.The assembly government said the new unisex scrubs would clear up confusion about who does what.Ward sisters will wear navy blue, clinical specialist nurses royal blue, staff nurses sky blue and healthcare support workers will wear green."

It's a waste of time. Patients and visitors think that anyone walking around the ward in uniform is some kind of nurse. The fact is that the nurse is massively outnumbered by untrained staff and those who are at a level above staff nurse do not come near the wards. Our uniforms are currently colour coded with a different coloured stripe designating our rank so to speak. I do believe that we need better uniforms and laundry facilities and changing rooms. But I do not have any confidence in the fact that the public understands what a nurse is or understands the difference between a nurse and a care assistant.

When patients need a bedpan or a drink they think the ask for the "Nurse". I would like to be doing those things for people, as I know that they appreciate it and are grateful for any help. But the fact is that if I am in the middle of the drug round, ward rounds, emergencies and I am the only nurse with a few care assistants then I HAVE to delegate these things to the care assistants.

The 3 hour drug round to get everyone their 8 AM medications will turn into a 6 hour drug round if I do not delegate all the simultaneous requests for the commode that I get while focusing on the drugs etc to the care assistants. It's not like the care assistants can carry on with my work while I stop to help with toileting. The vast majority of errors etc that I have seen during the course of my career occurred because of nurses being interrupted for these kinds of things. I am already going to be getting interrupted constantly for things like phone calls, visitors, doctors orders, admissions etc anyway. The care assistants cannot help me with that either.

This leads to patients saying things like "That nurse (the care assistant) was kind enough to stop and help me wash my back but that mean nurse (the lone RN doing the drug round for 15 people while managing someone who needs constant monitoring) couldn't be bothered.

Even if the patients can differentiate between a nurse and the care assistants they are still going to ask for the "nurse" when they want something relatively minor. The nurse is usually up to her eyeballs with constant problems and cannot always get that commode. Nurses have to make quick decisions as to where they can go and when.

Janelle was a colleague of mine who got written up over something like this. She was a lone nurse for the ward with only care assistants to help. It was 7PM and she was still doing the drugs that should have been out at 5PM. She was running between a GI bleed and a COPD (infected excab) patient who was really kicking off as well, very short of breath and looking septic too. She had visitors of other patients up her backside wanting immediate answers. Sitting down with them and giving them those answers would have taken her away from the GI bleed and the COPD patient for too long. She was the nurse and had to deal with it all alone. The care assistants cannot help with things like this.

At one point she was drawing up some antibiotics and getting IV fluids reading for the COPD patient when the care assistant burst into the treatment room. "The woman in bed 3 says she must have a nurse right away. I told her that I am a care assistant and I can help but she says she wanted a nurse straight away". The patient in question often gets chest pain and Janelle thought that this must be why she wanted a nurse. So she legged it to bed 3. "I want a commode, that is why I demanded a nurse" says the woman in bed 3. "I am going to let Lena the care assistant to help with you with that right now because I have a situation with another patient who needs some medications" says Janelle. Cue the patient getting pissed off and complaining as a result of not understanding the situation. Cue Janelle being stupid and getting her a commode to appease her. Cue the medic showing up and pitching a fit because the IV antibiotics and IV fluids were not yet started on the copd patient and Janelle, the only RN, was handing out a commode while the care assistants twiddled their thumbs.. Janelle was complained about by both the patient asking for the commode and the medic of the poorly patient.

Nurses do not mind giving out commodes, cups of tea etc. But we are rarely in the position to do so. We did not create this situation, it is out of our hands. There is a lot of work that can only be done by a nurse and we are severely outnumbered by untrained staff who can really only help with basic care.

Colour coded uniforms are not going to change much. Nurses who are trying to concentrate and focus and get from one sick patient to another with drugs and treatments are still going to get interrupted constantly and asked to deal with things that the care assistants could handle. And we will continue to have mistakes and omissions as a result. I have seen severe mistakes occur because of it.

We are taught to prioritize but we have all walked away from things that we should NEVER have walked away from in order to prove that we are not "to posh to wash". And problems have occurred. I have seen patients harmed because their nurse was off helping other patients to get commodes. They are sensitive to the fact that people are accussing them of being "to clever to care" and then they do something stupid. I have seen more patients hurt by this rather than harmed by uncaring nurses.

Please realise that the nurses are professionals who are overwhelmed with their workload and understand that horrendous consequences can occur if they are not allow to focus and delegate. Please realise this rather than accusing them of being shirkers who are trying to get out of getting their hands dirty.

40 comments:

Do you think it is possible/feasible to tell patients and families what the different roles of staff are? It seems that at the moment, none of them know the difference between a nurse and an HCA, and no one is bothering to tell them. It's a throwback to the days of "thenurse" as the generic resource for everything. Which is great, if you've got the staff; but when you don't, it pays to know who needs to be asked for the cup of tea and who needs to do the meds.

(I say "bother" - I realize that may come off wrong. Clearly, you haven't got the time. But it doesn't seem to have been thought of by anyone. Colour coding uniforms presupposes that people know the difference and just lack a way to differentiate them on sight. It makes me wonder if management have thought about the underlying issue, which is that patients and family lack a clear understanding of the different roles of staff.)

We have actually been told not too tell them. I don't think that the management wants people to know. Telling patients how many patients we have and how few nurses there is is frowned on because it may stress out the patients. It's considered unprofessional and childish on the part of the nurse to stand there and tell patients "we really cannot cope bear with us".

I do introduce myself to my patients as "Annie, the RN who is your named nurse today".

But I cannot say "Hi I am Annie, your named nurse today as well as the named nurse for 15 other people. The other girls are care assistants"

If the patients get wind of how few nurses there are they might complain about that. And then management looks bad instead of the nurses looking bad. I think that management wants to stick with the nurses looking bad.

I think we should have a list of the nurse patient ratios in relation to the acuity posted on the doors when people enter the ward.

"This after noon we have only 2 nurses for the ward rather than 3 nurses like we had this morning. And patient acuity has increased due to new admissions. Please bear with us. We may not be able to stop and talk to you right away, as we are able to do on other shifts when there are more RN's."

Management won't allow it. It puts the blame on their door rather than onto the nursing staff.

Nurse Anne wrote: I do introduce myself to my patients as "Annie, the RN who is your named nurse today".

Do you introduce yourself, in those words, because YOU want to do it or because you are expected to do it? I ask because I think the form of words is asking for trouble. It sets you up in the mind of the patient as their own personal Nurse (capital N) when, in reality, there is no such thing. In fact, I'm amazed that the "named nurse initiative" appears to survive in your hospital - it was always a nonsense in my opinion, totally unconnected with the reality of day to day nursing care e.g. shift systems, working in teams, annual leave and so on. Why beat yourself up for trying to do the impossible. I say, bin it...

In those days hospitals also provided changing rooms and laundry facilities.

Student nurses wore yellow and here's the real point of my comment. In those days student nurses were real, and significant, members of ward and departmental nursing teams. In relation to the issue in your blog post Nurse Anne, a student nurse would act as an intermediate source of help between the HCA and the trained nurse. Now, you are more likely to get it all directly and it's hard.

For me, in relation to the issue you describe, an interesting question is whether nurse education could have been upgraded to DipHE/BSc standard without adopting hook, line and sinker, a particular model of education and making students supernumerary to clinical nursing teams. I'm sure it probably could.

As to whether nurse education could now be changed to go "backwards," well as the new Welsh uniform colours indicate backwards is clearly the new forwards...

But...they would have to be pretty silly to think that they have their own personal nurse outside of ITU.

We have students on the wards at all times. When they come, management floats the care assistants away so that they students are used as care assistants. Answering all the constant call lights while trying to turn 15 people every 2 hours, commodes and feeding is all time consuming on it's own. The student is very unlikely to be able to stay up to date enough to help answer visitor queries etc.

Think for a minute about turning 15incontinant patients every 2 hours. Most will be soiled when you get to them. It takes about 20 minutes per patient. By the time you get to the last few it is well more than 2 hours since you have turned the first. And they are developing sores. This has to be done all around the clock. When the students come managers get rid of the hca's for that shift and use them to staff another area i.e. a holding area for a&e patients who are breaching targets.

I'll tell you sometime about the student nurse who was failed out of school for giving a patient a prescribed med that he needed. It was fucking paracetamol. It was due, it was ordered, the nurse was busy. The student was failed over it by the UNi

Nurse Anne wrote: But...they would have to be pretty silly to think that they have their own personal nurse outside of ITU.

Would they (have to be pretty silly to think that)? Why?

So what's the point of telling them that you're "their named nurse" when it doesn't mean much? What exactly do you expect them to understand by that?

As for students, well I only mentioned them because you don't seem to mention them much, so I assumed you had none, or very few. In any case, my point about supernumerary students still stands. "In the past" (sorry) a ward like yours might have, oh I don't know, a couple of third years, maybe even a very senior third year who might be treated, informally of course, as a staff nurse, a couple of second years and a couple of first years all working the same shifts as the regular ward staff. Under P2K it was intended that hours lost by making students supernumerary would be made up by better trained HCA and... more trained nurses. Did this happen? Goodness knows...

I wasn't suggesting that students should be dealing with visitor enquiries - merely that I think patients would understand that a nursing student was closer to being a Nurse (capital N) than an HCA.

Yes, it is silly to think that. Why the hell would you get your own private duty nurse on a general ward.

If you can see that there are 30 other patients and only a handful of staff why would you think that you are so special. If you do have a one to one registered nurse on a general ward, and she is caring for you while ignoring everyone else that is a very bad sign. You are probably about to crash.

Oh and glam, the patients cannot tell the difference between care assistants, students, and staff nurses anyway. Not at all. Not if the nurses were in hot pink dresses, and the care assistants were in blue suits, and the students were in yellow.

If we had our status tatooed on our foreheads they still wouldn't get it. They would still classify us all as "nurses". My pet peeve that.

To the patients and visitors anyone walking around in a uniform gets called nurse....my hard earned professional title.

"It is silly to think that if someone introduces themself as your named nurse that it means that you are their only patient."

OK so you don't accept my suggestion that the named nurse system might create unrealistic expectations in the mind of a patient who is unfamiliar with the workings of the NHS. How then do YOU explain the incidents that you described in your original blog? How would you set about dealing with them or changing patients' expectations?

You wrote: "Yes, it is silly to think that. Why the hell would you get your own private duty nurse on a general ward."

I agree entirely so why do you introduce yourself as a patient's named nurse? What does it actually mean - to the patient, that is? What is the use of the named nurse system? I say it's pointless and would save a lot of confusion if it was binned but you don't seem to agree. Ah well, that's fine, but I'd still like to know why you seem to like it.

You wrote: "Oh and glam, the patients cannot tell the difference between care assistants, students, and staff nurses anyway. Not at all. Not if the nurses were in hot pink dresses, and the care assistants were in blue suits, and the students were in yellow."

I would tend to agree but this rather contradicts the story in your blog post when a patient insisted that her commode had to be brought by a Nurse (capital N). Evidently she could tell the difference...

Either you are a nurse or you are not a nurse. No such thing in my book as an unqualified nurse.

Ahh I get you. It's the English thing with nursery nurses and dental nurses. I did spend a bit of time outside the UK and was educated overseas. No one in their right mind would call a babysitter who works in a nursery any kind of a "nurse".

She asked the care assistant if she was a nurse and of course the care assistant said no. The patient screamed "Well I need a nurse". By "Nurse", the patient meant "the member of staff who gets commodes". Which is silly really, because of all the staff on a ward, the nurse is the person who is least likely to be able to get a commode. This is not the nurses fault of course.

I've asked several quite specific questions in my previous comments and I don't think you've answered any of them. I still don't know why you keep up the named nurse system. I still don't know what you think anyone gets out of you introducing yourself to patients as their named nurse. I still don't know how you think patients' expectations of nurses could be changed but you don't seem to have any actual ideas about that either.

Instead of dealing with my questions you avoid discussion by introducing irrelevancies (I didn't use the term "unqualified nurse" so I don't know why you mention it). Even better, you invent facts: it is just not true that "You have to be an RN to be a nurse." You have to be a Registered Nurse to be a Registered Nurse but anyone can call themselves a nurse.

You record this bizarre incident "She asked the care assistant if she was a nurse and of course the care assistant said no. The patient screamed "Well I need a nurse". By "Nurse", the patient meant "the member of staff who gets commodes.""

As you say, the patient probably meant something like "are you the member of staff who gets commodes." I wonder why the HCA didn't investigate this hypothesis before rushing off to look for the Nurse (capital N). I wonder why the HCA didn't think of, just temporarily, accepting the informal status of nurse (small n) in order to find out whether the patient had a nursing problem that she could properly assist her with. Something like "No but I'm her assistant, can I help?" Or "No, but I'll get her, can you tell me what's wrong?" might have done the trick and avoided the situation you describe.

But still, I'm wasting my time because you now think I'm a Troll. I'm not, unless you define a Troll as someone who asks difficult questions, I'm just mightily irritated by the stuff you write. In any case, I'm sure you'll recognise that calling me a Troll is just another way to avoid actual discussion (as opposed to ranting) about the mess you work in.

In reading through the above debate, none of it would be an issue if there were enough staff (qualified & unqualified) on the wards to adequately look after the patients.

RNs could introduce themselves as "your nurse/named nurse/one of the nurses etc" without fearing misunderstanding on the patients behalf regarding 'personal' nurse. (Although I do think that it is unlikely that anyone would be genuinely daft enough to expect a 'personal' nurse in an NHS hospital.)

As for students learning clinical skills...on the wards it is a very hit and miss situation. I can only speak from my own experience, as a P2K student, as a ward nurse in the past, and as a A&E Nurse now. Student learning depends very much upon the workload of the RN mentor. If the RN is bogged down (due to poor ratio's) with simultaneous stressful situations (ie crashing patients, overwhelming list of priority treatments for other patients, over-due drug round, complex IVs, relatives, documentation, complex discharges and new admissions etc)then the head-space and the TIME to teach as you go along is just not there.

As a student nurse I recall checking the ward rota's to look at RN staffing levels - because then I'd know what to expect in the way of teaching.

Poor staffing = bed making, tea making, following RN around to try to understand actions/interventions... asking questions but generally feeling in the way.

Good staffing = opportunities to perform clinical skills under supervision, with discussions regarding related theory. Assisting with caring for the crashing patient with discussions regarding patient assessment and interventions.

As a staff nurse on the wards I found it very difficult to teach clinical skills, which was disappointing. There was always too much to do, too little time. Whether the students were supernumerary or not didn't come into it for me personally. I was still the only RN to 15+ patients, and unable to delegate many things.

Now in A&E, due to better nurse/patient ratio's, I can teach clinical skills without compromising patient care. The supernumerary status is positive, because it enables students to be directed to wherever the best learning opportunity is at any given time. This is how it should be everywhere - this is what creates capable newly qualified nurses.

Nurse patient ratio's affect everything, not just the quality of care provided to patients.

"I've asked several quite specific questions in my previous comments and I don't think you've answered any of them. I still don't know why you keep up the named nurse system."

...Your questions seem pointless and arguement provoking...I don't get the point in your questions.Nurse Anne is not responsible for the 'Named Nurse' thing...that would be her directorate or managers. Not Anne personally, so how can she answer for its use on her ward.

Glam. You seem to have issues with Nurse Anne documenting very real experiences. Experiences that I (as a nurse) can very much relate to. As do other nurses.

You (I presume - so correct me if i'm wrong) are not a nurse. Therefore you can't relate to these very real experiences.

I asked you a question on a previous post, which you failed to answer. "What job do you do?"

Happy1: Ah, I think you called me a "twat" in our previous correspondence. Nice... but still, I'm glad you've taken the trouble to write a proper reply this time.

Your first sentence goes to the heart of why I commented. You wrote: "...none of it would be an issue if there were enough staff (qualified & unqualified) on the wards to adequately look after the patients." Perfectly true but it is an issue because if there are not enough staff on the wards now, after 10 years of enormous spending on the NHS, then I think you can take it that there are never going to be enough staff, so you have to live with what you have.

I suggested that the named nurse system might have contributed, perhaps in a small way, to the situation Anne described so I asked questions about why it still exists (after all it was set up around 1991/92 by the then Conservative government and has been criticized heavily since for all sorts of reasons including the one that it could only work if staffing levels were adequate...). You say that Anne is not responsible for "the named nurse thing... on her ward." Agreed, but what I'm interested in on this occasion is why it still exists, and what use it it, given that conditions in the NHS are totally unsuitable for it. I think it was, and is, a nonsense but I wanted to know what Ann (or any other correspondent) thought about it but I still don't know and it doesn't look as if I ever will. That, Happy1, was the point of my questioning.

As to what I do, well that's none of your business and irrelevant anyway (in any case, this is cyberspace and I could tell you all sorts of rubbish and you'd be none the wiser). All that matters is the argument and I'm sorry to see that with all these posts we've not taken that forward at all.

"I suggested that the named nurse system might have contributed, perhaps in a small way, to the situation Anne described so I asked questions about why it still exists....what I'm interested in on this occasion is why it still exists, and what use it it, given that conditions in the NHS are totally unsuitable for it...I wanted to know what Ann (or any other correspondent) thought about it but I still don't know and it doesn't look as if I ever will"

So why didn't you say.."What do you all think about named nursing etc...?"

In a non-challenging way?

Because you are 'mightily irritated by what Nurse Anne writes.

Why?

What is it EXACTLY about Nurse Anne's posts that irritate you so much?

I ask, because it is all REALITY, and a blog is about venting...right?

And other than an (?NHS) manager, I can't think of anyone else who would have reason to be so 'mightily irritated' by the REALITIES that Anne writes about.

I really think you're being willfully obtuse here, Glamorganist. It seems obvious to me (and I'm American by birth--where you can get private duty nursing, if you can pay for it) that "named nurse" only means that nurses are in charge of particular patients, not that she's a private duty nurse. It means that I need to ask Anne questions, not Jane or Sally or Isabel. Now, true, I am probably rather better informed than many of the patients/families Anne describes--I know enough about how healthcare and hospitals work to know something about the different roles. Nonetheless, I don't think I would ever in my life have expected a nurse of my own in hospital.

Outside of ICU (and even there, not always) I would never expect an RN to myself without forking over an eye watering sum. And on the NHS where this is not allowed? Surely, you jest.

I am sure that glam is some kind of NHS manager trying to pick apart what I/we say in order to build a defense of some kind.

I cannot believe that anyone could think that a ward could function these days without each group of patients having a named nurse for the shift. Someone has to pull it all together and it is safer to be pulling it together for 12 people rather than all 24.

Named nurse - doesn't work in my experience. I don't think you have to tell patients that you are the only RN for 15 of them but I'd certainly be saying "my name is Anne and I'll be looking after this side of the ward/these 3 bays this morning/evening with 'Betty' and 'John' the HCAs. They can help you with washing, toileting, cutting up your inedible food/fighting your way into your TEDs. They can't help with medicine or things like fixing your drip. I'll be along to do that."

We used to have a board on the ward with staff photos and their titles. We hated the idea at first but it gives patients and rellies something to look at and familiarise themselves with who's who in terms of different uniforms etc.

The other thing is some sort of written information sheet for patients explaining who's who by uniform and giving a brief outline of their role and limitations.

I think a huge part of your problem, Anne, is that you work in bays. At least with a Nightingale ward the other patients knew you were about. Your lot are stuck in bays and can't see you. They've spent all day reading the Daily Mail and are convinced that you're glued to the computer or are rubbing dirt under your fingernails somewhere.

What it all boils down to, however, is that your hospital is located in one of the lower circles in Dantes Inferno. Someone needs to get a big whistle and blow very hard.

When I was first in hospital I realised that I knew NOTHING about the organisation. All I knew was that consultants are important doctors. I didn't know anything about other grades of doctor or nurse, students, technical staff, or care assistants. Or ward rounds, or drug rounds, visiting hours, or any basic organisational stuff. And the whole place was alien and hard to get used to, you constantly felt you were asking the wrong person. I remember surreptitiously reading an SHO's badge and wondering whether he was senior to the registrar.

So I can understand people getting confused about what nurses do, and I think it would be good to give the information somehow. Who does teas and who does drugs, who gets commodes and who explains treatment plans. Maybe a leaflet or poster. It would help to know who does what, and why.

I sound pretty stupid I expect but it was the unfamiliarity, plus it's not a situation where you feel calm and in control anyway.

As a patient, I liked the board of names SSS mentioned - you could check for names you forgot rather than feel rude - and when I am stressed I forget everything fast.

The nurses know that communication is bad and we have already thought of boards, photos, etc 100 times over.

Management shot us down. If we have better communication with patients then the patients will understand the situation and blame management for all the shortcomings rather than front line staff (as they do now). Management does not want to take blame. If the public is ignorant of what goes on then they are more likely to blame frontline staff.

"No but I'm her assistant, can I help?" Or "No, but I'll get her, can you tell me what's wrong?"

When care assistants say this exact line to patients do you know what the patients say

" I don't care who you are and I am not telling you what is wrong, I want my NURSE"

Commodes etc are very private things and certain patients often feel that the only person they can talk to is the nurse. They don't understand what a care assistant is and may not want to discuss such things with a non nurse.

As soon as the care assistant told the patient that no, she wasn't the nurse the patient closed all lines of communication and demanded a nurse. full stop.

This is a regular occurance. It really should ahve been obvious from my blog post that this is what occurred. Can't go any more into detail really but the sex of the care assistant and the age and sex of the patient was a bad combination. Yes, the care assistant asked what was wanted. The patient was not wanting to communicate with this person.

As far as the named nurse things goes I will try and explain it again.

"The other RN on the ward won't know about you because she is dealing with the bottom end of the ward. I am your nurse because I am up here with you and the patients at the top end of the ward."

I may have 15 patients, but I am the named nurse for you and your group.

It does not work to have all the staff on duty for a shift to stay up to date on all the patients information. 7 hours into the shift and it is dangerous for me to go near the other RN's patients because I am not up to date at all. We would have to spend all of our time constantly handing over to eachother in order to stay up to date. We do not have time to hand new information over to eachother constantly. If we were all able to know all the up to date information on all patients at all times then we would have no need for the named nurse stuff.

Honestly, it really doesn't work.

There is going to be an RN on the ward who is up to date with all the information about you, whilst the only other RN doesn't really know a thing about you.

Remember Glam, there are usually only two of us with no choice but to split the ward in half.

What SSS suggested (giving the patients leaflets describing uniforms)plus putting photographs of staff on a notice board would be the best option. When I was a 'third-year senior student' (as someone described it which made me chuckle wryly) I was told to "act as though I was a staff-nurse". Although most unqualified staff were helpful a few of them expressed their opinion that "she's only a student so I don't have to do what she tells me". They were repeatedly impertinent and refused to follow instructions. This made things extremely difficult and could even have been potentially dangerous. Sadly, as a consequence, the general public definitely gained the impression that I was acting above my station. I could hardly announce with a tannoy that I was on the brink of qualifying. I did raise this with senior staff but received no back-up or support whatsoever.

No matter what colour health care workers wear, people are STILL going to ask/think we're all nurses. So why bother colour code? Plus, we have NAME TAGS with our titles for a reason. We are in 2012now. Let us have a choice! As long as you're neat and professional looking, who cares what colour we wear. I just got my BSN (I'm 24 years old, and my closet is FILLED with new scrubs in: purples, greens, pinks, yellows, prints, ect.... and I'm stuck wearing dull blue day in-day out 'cause of annoying family memembers who can't read name tags or ask. On top of that, my boss calls me other co-workers names often because we ALL LOOK THE SAME!

Let's not resort back to the olden days, people. White scrubs? Please. Heck, why not bring the nursing caps back too. *Rolls eyes

We all have to wear white shoes/socks, nude underwear and undershirts. PLEASE do not take our choice of scrubs away. It took years to get prints and colours in.

In an atmosphere if universal deceit telling the truth is a revolutionary act. George Orwell.

Why has Nursing Care Deteriorated

Good nurses are failing every day to provide their patients with a decent standard of care. You want to know what has happened? Read this book and understand that similiar things have happened in the UK. Similiar causes, similiar consequences. And remember this. The failings in care have nothing to do with educated nurses or nurses who don't care. We need more well educated nurses on the wards rather than intentional short staffing by management.

About Me

I am a university educated registered nurse. We had a hell of a lot of hands on practice as well as our academic courses. The only people who say that you don't need a brain or an education to be an RN are the people who do not have any direct experience of nursing in acute care on today's wards. I have yet to meet a nurse who thinks that she is above providing basic care. I work with nurses who are completely unable to provide basic care due to ward conditions.
I have lived and worked in 3 countries and have seen more similarities than differences. I have been a qualified nurse for nearly 15 years. I never used to use foul language until working on the wards got to me. It's a mess everywhere, not just the NHS.
Hospital management is slashing the numbers of staff on the ward whilst filling us up with more patients than we can handle... patients who are increasingly frail. After an 8-14 hour shift without stopping once we have still barely scratched the surface of being able to do what we need to do for our patients.

Quotes of Interest. Education of Nurses.

Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."...Journal of advanced nursing 2007

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level.

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania's Center for Health Outcomes and Policy Research found that patients experienced significantly lower mortality and failure to rescue rates in hospitals where more highly educated nurses are providing direct patient care.

Evidence shows that nursing education level is a factor in patient safety and quality of care. As cited in the report When Care Becomes a Burden released by the Milbank Memorial Fund in 2001, two separate studies conducted in 1996 - one by the state of New York and one by the state of Texas - clearly show that significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree and diploma levels as compared with the baccalaureate level.

Registered Nurse Staffing Ratios

International Council of Nurses Fact Sheet:

In a given unit the optimal workload for a registered nurse was four patients. Increasing the workload to 6 resulted in patients being 14% more likely to die within 30 days of admission.

A workload of 8 patients versus 4 was associated with a 31% increase in mortality. (In the NHS RN's each have anywhere from 10-35 patients per RN. It doesn't need to be this way..Anne)

Registered Nurses in NHS hospitals usually have between 10 and 30+ patients each on general wards.

Earlier in the year, the New England Journal of Medicine published results from another study of similar genre reported by a different group of nurse researchers. In that paper, Needleman et al3 examined whether different levels of nurse staffing are related to a patient’s risk of developing complications or of dying. Data from more than 5 million medical patient discharges and more than 1.1 million surgical patient discharges from 799 hospitals in 11 different states revealed that patients receiving more care from RNs (compared to licensed practical nurses and nurses’ aides) and those receiving the most hours of care per day from RNs experienced fewer complications and lower mortality rates than those who received more of their care from licensed practical nurses and/or aides. Specifically for medical patients, those who received more hours per day of care from an RN and/or those who had a greater proportions of their care provided by RNs experienced statistically significant shorter length of stay and lower complication rates (urinary tract infections, gastrointestinal bleeding, pneumonia, cardiac arrest, or shock), as well as fewer deaths from these and other (sepsis, deep vein thrombosis) complications

•Lower levels of hospital registered nurse staffing are associated with more adverse outcomes such as Pneumonia, pressure sores and death.
•Patients have higher acuity, yet the skill levels of the nursing staff have declined as hospitals replace RN's with untrained carers.
•Higher acuity patients and the added responsibilities that come with them increase the registered nurse workload.
•Avoidable adverse outcomes such as pneumonia can raise treatment costs by up to $28,000.
•Hiring more RNs does not decrease profits. (Hospital bosses don't understand this. They think that they will save money by shedding real nurses in favour of carers and assistants. The damage done to the patients as a result of this costs more moneyi.e expensive deaths, complications,and lawsuits, and complaints....Anne)

Disclaimer

I know I swear too much. I am truly very sorry if you are offended. Please do not visit my blog if foul language upsets you. I want to help people. That is why I started this blog and that is why I became a Nurse. I won't run away from Nursing just yet. I want to stick around and make things better. I don't want the nurses caring for me when I am sick working in the same conditions that I am. Of course this is all just a figmant of my imagination anyway and I am not even in this reality. Or am I?Any opinions expressed in my posts are mine and mine alone and do not represent the viewpoint of the NHS, the RCN, God, or anyone else.